Postoperative Outcome, Whipple Procedures
Conditions
Keywords
CO2 Pressure Difference, O2 Difference, Blood Lactate
Brief summary
Whipple surgery is a complex abdominal procedure associated with a high risk of hemodynamic instability and splanchnic hypoperfusion leading to anastomotic leaks, delayed gastric emptying, and organ dysfunction Traditional markers (e.g., MAP, mixed venous oxygen saturation \[SvO₂\], lactate) are indirect, invasive and often delayed. CO₂-derived variables (e.g., venous-to-arterial CO₂ gap \[ΔCO₂\], tissue CO₂ \[PtCO₂\], end-tidal CO₂ \[EtCO₂\] changes) provide earlier and more sensitive signs of microcirculatory dysfunction.
Detailed description
Whipple surgery is a complex abdominal procedure associated with a high risk of hemodynamic instability and splanchnic hypoperfusion leading to anastomotic leaks, delayed gastric emptying, and organ dysfunction Traditional markers (e.g., MAP, mixed venous oxygen saturation \[SvO₂\], lactate) are indirect, invasive and often delayed. CO₂-derived variables (e.g., venous-to-arterial CO₂ gap \[ΔCO₂\], tissue CO₂ \[PtCO₂\], end-tidal CO₂ \[EtCO₂\] changes) provide earlier and more sensitive signs of microcirculatory dysfunction. The present study investigate the hypothesis that simultaneous measurement of Venous-to-Arterial CO₂ Gap Indexed to Oxygen Content Difference (Pv-aCO₂/Ca-vO₂ Ratio & blood lactate may provide one or more early markers for post-operative adverse outcome in Whipple procedure
Interventions
OTHERpredictors of postoperative outcome in Whipple Procedures
CO₂-Derived Parameters & Lactate as Predictors of Postoperative outcome in Whipple Procedures and the occurrence of complications
Sponsors
Alexandria University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults (\>18 years) undergoing open Whipple procedure under general anesthesia * Invasive monitoring (arterial line and central venous catheter) * Informed written consent
Exclusion criteria
* Emergency surgery. * Preoperative septic shock or hemodynamic instability. * severe pre-existing \*\*cardiopulmonary disease (e.g., severe COPD, heart failure).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Venous-to-Arterial CO₂ Gap (Pv-aCO₂ = PvCO₂ - PaCO₂) | T0 baseline (After induction of anesthesia) T1 intraoperative (After major vessel dissection) T2 intraoperative (Immediately post-pancreatic resection) T3 intraoperative (After GIT anastomosis) T4 End of surgery T5 postoperative (2 hours) | Measured via arterial and central venous blood gases sampling throughout the Whipple procedure |
| Arterial-Venous oxygen content difference (Ca-vO₂ = CaO₂ - CvO₂) | T0 baseline (After induction of anesthesia) T1 intraoperative (After major vessel dissection) T2 intraoperative (Immediately post-pancreatic resection) T3 intraoperative (After GIT anastomosis) T4 End of surgery T5 postoperative (2 hours) in ICU | Measured via arterial and central venous blood gases |
| Veno-arterial CO2 Pressure Difference to Arterio-venous O2 Difference Ratio (Pv-aCO₂/Ca-vO₂ ratio ) | T0 baseline (After induction of anesthesia) T1 intraoperative (After major vessel dissection) T2 intraoperative (Immediately post-pancreatic resection) T3 intraoperative (After GIT anastomosis) T4 End of surgery T5 postoperative (2 hours) in ICU | calculated by dividing the previous 2 measurements (Pv-aCO₂/Ca-vO₂ ) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Occurrence of post-operative complications | postoperatively within 1 month | 30-day mortality |
| Traditional Perfusion Markers :Lactate | T0 baseline (After induction of anesthesia) T1 intraoperative (After major vessel dissection) T2 intraoperative (Immediately post-pancreatic resection) T3 intraoperative (After GIT anastomosis) T4 End of surgery T5 postoperative (2 hours) in ICU | Measured via arterial blood gases sampling |
| occurrence of postoperative complication as acute liver dysfunction | postoperatively within 3 days | Postoperative liver dysfunction is defined as new impairment in liver function occurring after surgery, typically within the first 48-72 hours, manifested by one or more of the following: 1.Hyperbilirubinemia Total bilirubin \> 2 mg/dL (34 µmol/L) OR a rise \> 50% from baseline, 2.Elevated Liver Enzymes Increase in AST or ALT greater than 2-3 × upper limit of normal (ULN) Coagulopathy INR ≥ 1.5 |
| occurrence of Organ dysfunction (AKI) | postoperatively within 3 days in ICU | Organ dysfunction (AKI), a patient is considered to have AKI postoperatively if any one of the following occurs: Increase in serum creatinine ≥ 0.3 mg/dL (≥ 26.5 µmol/L) within 48 hours, OR Increase in serum creatinine to ≥ 1.5 times baseline, OR Urine output \< 0.5 mL/kg/hr for ≥ 6 hours. |
| occurrence of Postoperative complications | within 3 days in ICU for complications, 30 days postoperatively for mortality | • Anastomotic leak rate (pancreaticojejunostomy, hepaticojejunostomy), Delayed gastric emptying (DGE), Postoperative pancreatic fistula (POPF), |
| ICU length of stay | postoperative 3 days | total ICU stay ( days) |
Contacts
Primary ContactAlaa Anwar Abdelrahman, MD
Outcome results
None listed